June 3, 2008 - Cardiologists around the country are speaking out against payment cuts that could force the closure of many outpatient catheterization labs, creating long waits and dramatically increasing out-of-pocket costs for thousands of Medicare beneficiaries, according to the Cardiovascular Outpatient Center Alliance (COCA).

Under proposed changes from The Centers for Medicare and Medicaid Services (CMS), reimbursement for cardiac catheterization procedures performed in non- hospital outpatient labs would be reduced 47 percent by 2010. Once fully implemented, non-hospital cath labs would receive reimbursements several hundred dollars below the cost of performing the procedure. Because private insurers typically follow CMS’s lead, the cuts could create a domino effect that would reduce reimbursements from all payor sources, driving many non-hospital labs out of business, said COCA.

More than 45 members of COCA, a non-profit organization representing more than 60 cardiology practices across the nation, recently met with members of Congress to ask them to intervene and request that CMS set fair and reasonable reimbursement consistent with the cost of the procedure.

“In addition to closing outpatient cath labs around the country, the proposed cuts would have a devastating effect on the entire healthcare system,” said Steve Blades, president of COCA. “Patients would be forced back into crowded hospital settings where the cost of the same procedure is significantly higher, resulting in long waits and greater out-of-pocket expense. As a result, the federal government would incur $45 to $50 million in increased costs, defeating the very purpose of these reductions.”

Based on published 2008 Medicare reimbursement numbers, patient copayments also would increase by $500 - or 157 percent - while access to catheterization services would be diminished. Medicare beneficiaries currently pay $326 for a catheterization procedure performed in a non-hospital lab while out-of-pocket costs for the same procedure in a hospital outpatient lab total $839.
While the proposed changes would significantly lower payments to non-hospital labs, hospitals performing the same procedure continue to receive increased reimbursement. Since 2006, hospitals have experienced a 25 percent increase in reimbursement for outpatient cardiac catheterizations even though research has shown that a hospital lab’s cost structure is the same as that of a non-hospital lab.

Despite similar procedure costs, hospitals typically charge more to perform a cardiac catheterization. According to COCA, non-hospital outpatient facilities can deliver the same service at a lower cost to the payor and the patient while providing enhanced convenience and better access to care.